iRadiology最新文献

{"title":"Leg mouse: “Tennis leg”","authors":"Siddhi Chawla","doi":"10.1002/ird3.59","DOIUrl":"10.1002/ird3.59","url":null,"abstract":"<p>A 25-year-old male presented to the orthopedic out-patient department with a small bulge on the back of the left lower leg which appears on the plantarflexion of the foot. It developed suddenly 5 days ago when the patient was running with a sharp pain in the calf (Figure 1a). On examination, there was a well-defined soft tissue density lesion in the medial side of the leg which became more pronounced on plantarflexion (Video S1). Ultrasound (done on Sonoscape P12) with a linear probe (9–12 Hz) revealed a bulky medial head of gastrocnemius with lobulated inferior edge contour at the site of the swelling with hyperechoic soft tissue at the inferior edge of the belly signifying buckled up aponeurosis at its inferior edge (Figure 1b,c; Video S2 shows the dynamic evaluation of gastrocnemius with curvilinear probe; Video S3 shows the normal contralateral side for comparison). The muscle became prominent on plantar flexion with increase in the buckling of the aponeurosis. The swelling disappeared on the dorsiflexion and on ultrasound findings returned to baseline. There was no intermuscular fluid or adjacent collection. A diagnosis of “Tennis leg” due to a partial rupture of the medial head of gastrocnemius at musculoaponeurosis junction was made.</p><p>“Tennis leg” is commonly seen in middle-aged persons and is a common sports-related injury or chronic stress due to strenuous exercise commonly occurs following the extension of the knee and forced dorsiflexion of the ankle because of playing tennis or activities such as jumping or running with “push-off” [<span>1</span>]. Other causes of “Tennis leg” include plantaris tendon rupture, partial rupture of soleus, fluid between the gastrocnemius and soleus muscles without the evidence of muscle injury, and even deep vein thrombosis [<span>2</span>]. Ultrasound is the first imaging modality of choice to look at the nature of lesion, exact location, place of origin, and differentiate muscular pathologies based on their location from other masses. It can also detect the deep vein thrombosis which appears as echogenic, non-compressible, thrombus within deep or superficial veins. Dynamic ultrasound adds to static imaging in cases with muscular injury by giving us a real time opportunity to assess the muscle and its relative movement with common maneuvers; like plantar and dorsiflexion in our case. Magnetic resonance imaging (MRI) is needed in cases where ultrasound is not able to localize or characterize the pathology. It helps us to differentiate gastrocnemius tear from other musculotendinous tears which can present similarly based on their location and much early than the ultrasound. It is also used in cases that require operative management to look at its operability with respect to grading of injury, any additional injuries and preoperative planning for reconstruction of tendons if required. In our case however, MRI was not performed in view of the partial tear of gastrocnemius documented on ultrasound. I","PeriodicalId":73508,"journal":{"name":"iRadiology","volume":"2 2","pages":"222-224"},"PeriodicalIF":0.0,"publicationDate":"2024-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ird3.59","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140446014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dual-modality imaging for identifying thrombosis via platelet GPIIb/IIIa receptor targeted cyclic RGDfK microbubbles","authors":"Yabin Wang,&nbsp;Yang Zhang,&nbsp;Ning Yang,&nbsp;Xiaoting Zhang,&nbsp;Sai Ma,&nbsp;Mengqi Xu,&nbsp;Yunxue Xu,&nbsp;Shan Gao,&nbsp;Yan Fang,&nbsp;Na Li,&nbsp;Sulei Li,&nbsp;Ping Liang,&nbsp;Xu Zhang,&nbsp;Li Fan,&nbsp;Feng Cao","doi":"10.1002/ird3.58","DOIUrl":"10.1002/ird3.58","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Acute thrombotic events play a major role in various cardiovascular diseases. Therefore, direct thrombus imaging can be proved beneficial for early diagnosis and prompt therapy of thrombosis. Our study investigated targeted dual-modality cyclic arginine-glycine-aspartic micro bubbles (cRGD-MBs) for direct imaging of thrombi by fluorescence and ultrasound.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>cRGD-MBs were prepared by mechanical vibration and chemical chelation methods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Coulter counter analysis demonstrated that the cRGD-MBs were well dispersed, with diameters ranging from 1 to 3 μm. They emitted bright red fluorescence under an excitation wavelength of 660 nm. In vivo fluorescence and ultrasound imaging revealed that cRGD-MBs accumulated at the site of thrombus in the carotid artery with significant fluorescence and ultrasonic signal.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study showed that novel microbubble cRGD-MBs were successfully synthesized, and that these could potentially be used as contrast agents for immediate diagnosis of acute thrombus in vivo.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73508,"journal":{"name":"iRadiology","volume":"2 3","pages":"227-239"},"PeriodicalIF":0.0,"publicationDate":"2024-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ird3.58","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139961805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the reproducibility, stability, and biological interpretability of multimodal computed tomography image features for prognosis in advanced non-small cell lung cancer","authors":"Jiajun Wang,&nbsp;Gang Dai,&nbsp;Xiufang Ren,&nbsp;Ruichuan Shi,&nbsp;Ruibang Luo,&nbsp;Jianhua Liu,&nbsp;Kexue Deng,&nbsp;Jiangdian Song","doi":"10.1002/ird3.56","DOIUrl":"10.1002/ird3.56","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Despite the existence of proposed prognostic features on computed tomography (CT) for patients with advanced-stage non-small cell lung cancer (NSCLC), including radiologists' handcrafted (RaH) features, radiomics features, and deep learning features, comprehensive studies that examine their reproducibility, stability, and biological interpretability remain limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The Image Biomarker Standardization Initiative-reported tolerance, Kappa, interclass correlation coefficient, and coefficient of variance were employed to identify reproducible features among RaH, radiomics, and deep learning features derived from NSCLC phantoms. The reproducible features were then input into six artificial intelligence algorithms to develop prognostic models for targeted therapy and immunotherapy using real-world patients with advanced-stage NSCLC to assess their capability and stability. Pathway enrichment was also conducted to explore the underlying biological pathways associated with these reproducible features.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Reproducible features in advanced NSCLC included RaH features (9/9, 100%), radiomics features (572/1835, 31.17%), and deep learning features (3442/4096, 84.03%). Among the six artificial intelligence-based prognostic methods, the RaH features exhibited least variability. We also observed that the optimal CT-based prognostic approach differed depending on treatment regimens for advanced NSCLC. In analysis using the Cancer Genome Atlas Program lung adenocarcinoma dataset, the identified reproducible prognostic features, specifically tumor size-derived radiomics and RaH features, showed significant associations with five key signaling pathways involved in NSCLC survival outcomes (false-discovery rate <i>p</i> &lt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>By elucidating the reproducibility, stability, and biological associations of prognostic CT features, our study provides valuable evidence for future NSCLC studies and modeling approaches.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73508,"journal":{"name":"iRadiology","volume":"2 1","pages":"3-16"},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ird3.56","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139803110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the reproducibility, stability, and biological interpretability of multimodal computed tomography image features for prognosis in advanced non‐small cell lung cancer","authors":"Jiajun Wang, Gang Dai, Xiufang Ren, Ruichuan Shi, Ruibang Luo, Jianhua Liu, Kexue Deng, Jiangdian Song","doi":"10.1002/ird3.56","DOIUrl":"https://doi.org/10.1002/ird3.56","url":null,"abstract":"Despite the existence of proposed prognostic features on computed tomography (CT) for patients with advanced‐stage non‐small cell lung cancer (NSCLC), including radiologists' handcrafted (RaH) features, radiomics features, and deep learning features, comprehensive studies that examine their reproducibility, stability, and biological interpretability remain limited.The Image Biomarker Standardization Initiative‐reported tolerance, Kappa, interclass correlation coefficient, and coefficient of variance were employed to identify reproducible features among RaH, radiomics, and deep learning features derived from NSCLC phantoms. The reproducible features were then input into six artificial intelligence algorithms to develop prognostic models for targeted therapy and immunotherapy using real‐world patients with advanced‐stage NSCLC to assess their capability and stability. Pathway enrichment was also conducted to explore the underlying biological pathways associated with these reproducible features.Reproducible features in advanced NSCLC included RaH features (9/9, 100%), radiomics features (572/1835, 31.17%), and deep learning features (3442/4096, 84.03%). Among the six artificial intelligence‐based prognostic methods, the RaH features exhibited least variability. We also observed that the optimal CT‐based prognostic approach differed depending on treatment regimens for advanced NSCLC. In analysis using the Cancer Genome Atlas Program lung adenocarcinoma dataset, the identified reproducible prognostic features, specifically tumor size‐derived radiomics and RaH features, showed significant associations with five key signaling pathways involved in NSCLC survival outcomes (false‐discovery rate p < 0.05).By elucidating the reproducibility, stability, and biological associations of prognostic CT features, our study provides valuable evidence for future NSCLC studies and modeling approaches.","PeriodicalId":73508,"journal":{"name":"iRadiology","volume":"96 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139863318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Appreciation, best wishes, and future prospects for 2024","authors":"Zhen Cheng","doi":"10.1002/ird3.57","DOIUrl":"10.1002/ird3.57","url":null,"abstract":"<p>As we embark on the first issue of 2024, on behalf of the <i>iRADIOLOGY</i> editorial board, I extend warm greetings and best wishes to our esteemed editorial board members, authors, reviewers, and readers. Together, we have witnessed the rapid evolution of medical imaging and the resilience of the human race post-epidemic. In this new year, filled with hope and challenges, let us collectively contribute our insights and efforts to advance the development of medical imaging.</p><p>I express my deepest gratitude to all authors for their selfless dedication, enabling the journal to uphold high academic standards. In <i>iRADIOLOGY</i> 's inaugural year, we received outstanding manuscripts from around the world, covering diverse aspects of medical imaging. Thirty-seven excellent articles originating from 13 countries have been accepted and published in four issues, propelling <i>iRADIOLOGY</i> to new heights on the international stage of medical imaging. Sincere thanks are also given to our reviewers, whose rigorous academic attitude and high sense of responsibility guaranteed the high quality of published articles last year.</p><p>The field of medical imaging has rapidly evolved, with the applications of new imaging techniques and probes such as theranostic radiopharmaceuticals providing valuable options for cancer diagnosis and treatment. Artificial intelligence, exemplified by technologies such as chatGPT, has transformed clinical practices, making image processing and analysis more intelligent and efficient. To adapt to the swift development of medical imaging and better serve the academic community, <i>iRADIOLOGY</i> will transition from a quarterly to a bimonthly journal in the upcoming year. This transformation aims to accommodate more cutting-edge research outcomes and ideas in interdisciplinary medical imaging, promoting the field's future development and providing unique insights. The success of this transformation relies on the continuous involvement and contribution of the editorial board, authors, readers, and medical imaging researchers. I believe that after this transformation, <i>iRADIOLOGY</i> will share more outstanding breakthroughs, promote interdisciplinary cooperation, and have a greater academic impact in the field.</p><p>Additionally, we will strengthen international cooperation, establish more partnerships with renowned academic societies and conferences, and actively participate in global medical imaging activities. We will follow cutting-edge trends, encourage interdisciplinary research cooperation, and promote the innovation and development of medical imaging technology. To further enhance the visibility of <i>iRADIOLOGY</i>, a wider outreach program will be launched through various channels, expanding the influence and recognition of our journal.</p><p>In the new year, 2024, we anticipate more challenges and opportunities. Let us remain optimistic and committed to advancing medical imaging. Together, let us contribute ","PeriodicalId":73508,"journal":{"name":"iRadiology","volume":"2 1","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ird3.57","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139871030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Appreciation, best wishes, and future prospects for 2024","authors":"Zhen Cheng","doi":"10.1002/ird3.57","DOIUrl":"https://doi.org/10.1002/ird3.57","url":null,"abstract":"","PeriodicalId":73508,"journal":{"name":"iRadiology","volume":"5 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139811281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of Point-of-Care Ultrasound of pupil for pupillometry in subarachnoid hemorrhage","authors":"Priyanka Modi,&nbsp;Sanjeev Bhoi,&nbsp;Pallavi Sinha,&nbsp;Savan Pandey","doi":"10.1002/ird3.52","DOIUrl":"https://doi.org/10.1002/ird3.52","url":null,"abstract":"<p>A 60-year-old woman presented to the emergency department, previously diagnosed in other hospital with acute subarachnoid hemorrhage (SAH) involving left proximal Sylvian and anterior interhemispheric sinuses. On presentation, her airway was patent, pulse rate was 86 beats per minute, blood pressure was 112/76 mmHg, respiratory rate was 18 beats per minute, SpO₂ was 99% on room air, Glasgow Coma Score was 11 (E3V3M5), and pupils were bilaterally (B/L) mid-dilated, reactive to light, and afebrile to touch. Neurological examination was limited due to altered sensorium: No neck rigidity; sensory functions, all cranial nerves, and cerebellar signs were not assessed; motor examination: power could not be assessed; B/L upper and lower limbs tone were decreased; B/L upper and lower limbs reflexes were normal; and B/L Plantar flexion were present. Her laboratory parameters were sodium 146.4 mmol/L, potassium 4.53 mmol/L, chloride 119.3 mmol/L, total bilirubin 55.23 μmol/L, creatinine 90.17 μmol/L, urea 8391.61 μmol/L, and INR 1.127.</p><p>A linear probe (frequency of 7–12 MHz) of Point-of-Care Ultrasound (POCUS) systems was utilized for pupillometry. There was anisocoria of 0.7 mm (the size of right and left pupils were 4.2 and 3.5 mm, respectively, Figure 1a,b). The bilateral pupil during direct light stimulation revealed briskly reactive pupils with rebound dilatation (Video 1a,b). However, the bilateral pupil during consensual light stimulation revealed a normal reactive pupil with no rebound dilatation (Video 1c,d). The patient was managed conservatively and referred to another hospital. She had decompression craniectomy on further deterioration of GCS. She died after 1 month due to infective complications of surgery.</p><p>Intracranial pressure can be raised due to any supratentorial mass lesion or head trauma. A common problem in the emergency department is how to decide when operative decompression is urgently required in them. Although computed tomography scans are standard tests for definitive diagnosis of brain stem compression, it is inconvenient to use to monitor for the requirement of surgical intervention. In addition, a more precise assessment of the pupil by manual examination is problematic due to large inter-examiner variability. Hence, there are no specific manual pupillary assessment findings for diagnosing brain stem compression. Some clinicians suggest that infrared pupillary scan findings, such as anisocoria of greater than 3 mm and reduced light reflexes, are predictive of an expanding mass lesion in the brain [<span>1</span>]. However, portable infrared pupillometers are not widely available. On the other hand, POCUS, a simple, objective, and quick imaging tool with an additional advantage of recording, is increasingly available for emergency imaging needs [<span>2</span>].</p><p>The raised intracranial pressure, sequelae of acute nontraumatic SAH, may cause compressive optic neuropathy and papilledema. Complication","PeriodicalId":73508,"journal":{"name":"iRadiology","volume":"2 1","pages":"99-101"},"PeriodicalIF":0.0,"publicationDate":"2024-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ird3.52","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139942938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hepatic adrenal rest tumor presenting as a giant cystic lesion with regular wall nodule","authors":"Yu Liu,&nbsp;Donghua Sun,&nbsp;Heng Liu","doi":"10.1002/ird3.50","DOIUrl":"10.1002/ird3.50","url":null,"abstract":"<p>Adrenal rest tumors are rare tumors at extra-adrenal sites that are derived from the heterotopic adrenocortical tissue. The frequency of hepatic adrenal rest tumors (HARTs) is exceedingly rare. Most reported HARTs are located under the capsule of segment VII and appear as a small well-circumscribed solid round mass with hypervascularity, a fatty component, and foci of calcification [<span>1-7</span>]. HARTs may be indistinguishable from hepatocellular carcinoma on imaging studies, which makes accurate preoperative diagnosis difficult.</p><p>A 56-year-old woman presented with an 8-month history of right upper abdomen distension and discomfort. She had no history of malignancy or chronic liver disease. Hepatitis viral markers were negative, and serum concentrations of alpha fetoprotein were within normal range. CT images showed a giant cystic lesion in the right lobe of the liver (Figure 1). A regular oval wall nodule had spotty calcifications along its anterior edge. The right adrenal gland was displaced and clearly demarcated from the tumor. The cyst wall and wall nodule demonstrated contrast enhancement. A right hemihepatectomy was performed. Immunohistochemical staining was positive for the adrenal cortical cell markers CD56, steroid growth factor-1, and inhibin-α; staining for chromogranin A was negative. The final histopathologic diagnosis was HART [<span>1, 3, 8</span>].</p><p>We report a rare atypical HART that differed from previously reported cases in terms of associated symptoms, size, and imaging characteristics [<span>1-7</span>]. Despite its rarity, this case highlights that HART should be considered in the differential diagnosis when a giant cystic liver lesion with regular wall nodule is encountered in the right lobe, especially in a patient with normal alpha-fetoprotein concentration.</p><p><b>Yu Liu</b>: Writing - original draft (lead); resources (equal). <b>Donghua Sun</b>: Writing - original draft (equal). <b>Heng Liu</b>: Resources (equal); writing - review &amp; editing (lead).</p><p>The authors declare no conflict of interest.</p><p>Not applicable.</p><p>Not applicable.</p>","PeriodicalId":73508,"journal":{"name":"iRadiology","volume":"2 2","pages":"220-221"},"PeriodicalIF":0.0,"publicationDate":"2024-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ird3.50","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139606519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical application of 99mTc-labeled peptides for tumor imaging: Current status and future directions","authors":"Jiyun Shi,&nbsp;Shuang Liu","doi":"10.1002/ird3.55","DOIUrl":"10.1002/ird3.55","url":null,"abstract":"<p>Targeting receptors overexpressed on cancer cells with radiolabeled peptides has become a crucial aspect of molecular imaging in oncology. Small peptides offer favorable characteristics for tumor targeting with minimal side effects and toxicity owing to their small size and simple radiolabeling protocols. Among them, somatostatin analogs have received regulatory approval for the diagnosis and treatment of neuroendocrine tumors. Cyclic RGD (Arg-Gly-Asp) peptides, bombesin analogs, and glucagon-like peptide-1 analogs are currently under development and/or undergoing clinical trials. The most used radionuclides for tumor imaging include ^99mTc and ¹¹¹In for single-photon emission computed tomography, ⁶⁸Ga and ¹⁸F for positron emission tomography. This review highlights the clinical potential and future prospects of ^99mTc-labeled peptides for tumor imaging.</p>","PeriodicalId":73508,"journal":{"name":"iRadiology","volume":"2 1","pages":"17-34"},"PeriodicalIF":0.0,"publicationDate":"2024-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ird3.55","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139610424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complicated infection in the mediastinum with aortoesophageal fistula—X-ray and computed tomography imaging","authors":"Aleksandar Pavlovic,&nbsp;Ljubica Sedlar,&nbsp;Katarina Lazarevic,&nbsp;Jelica Vukmirovic,&nbsp;Tarik Plojovic,&nbsp;Ksenija Mijovic,&nbsp;Dragan Vasin,&nbsp;Dragan Masulovic","doi":"10.1002/ird3.49","DOIUrl":"10.1002/ird3.49","url":null,"abstract":"<p>Aortoesophageal fistula is a rare, but life-threatening complication of several conditions [<span>1, 2</span>]. Computed tomography (CT) angiography is the diagnostic modality of choice [<span>3, 4</span>]. There is no consensus on therapeutic strategy [<span>1</span>].</p><p>A 73-year-old woman presented with severe chest pain and pressure, shortness of breath, and sweating. She also had a fever and low blood pressure. During observation, she began vomiting blood, lost consciousness, and became hemodynamically unstable. Chest X-ray showed mediastinal widening with a suspected aneurysm of the thoracic aorta and gas outlining the mediastinal structures, suggestive of pneumomediastinum (Figure 1).</p><p>CT angiography revealed mediastinal fat stranding, edema, fluid collections, and free gas inclusion. In the differential diagnosis, esophageal perforation with mediastinitis was assumed, but an infectious aneurysm was also considered due to the periaortic gas distribution (Figure 2). There were no previous data in the patient's history and anamnestic or imaging findings. Extensive gas locules around the esophagus were highly suggestive of esophageal perforation (Figure 2a). The esophagus was filled with hemorrhagic content, while the thoracic aorta was aneurysmally dilated, with irregular contours, overlayed by a thickened esophageal wall, with contrast extravasation into the lumen, clearly indicating an aortoesophageal fistula (Figure 2b,d).</p><p>Recurrent hematemesis and deterioration of the patient's condition unfortunately led to a fatal outcome, without surgery. Chest pain and progressive hematemesis are typical clinical signs of fistula [<span>4</span>]. Earlier indication of CT angiography could possibly increase the chances of survival [<span>2</span>]. Digital subtraction angiography could also clearly confirm the contrast extravasation [<span>3</span>]. Para-aortic fat stranding and fluid, as well as periaortic gas, may raise the suspicion of an infected aortic aneurysm [<span>5</span>]. Although we cannot determine the source of infection in this case with certainty, the presence of an aortoesophageal fistula was clearly demonstrated radiologically.</p><p><b>Aleksandar Pavlovic</b>: Conceptualization (Equal); data curation (equal); methodology (equal); visualization (equal); writing—original draft (lead). <b>Ljubica Sedlar</b>: Conceptualization (equal); formal analysis (equal); investigation (equal); methodology (equal); validation (equal); visualization (equal); writing—review and editing (lead). <b>Katarina Lazarevic</b>: Conceptualization (equal); formal analysis (equal); methodology (equal). <b>Jelica Vukmirovic</b>: Conceptualization (equal); methodology (equal). <b>Tarik Plojovic</b>: Data curation (equal); formal analysis (equal); methodology (equal); writing—original draft (supporting). <b>Ksenija Mijovic</b>: Conceptualization (equal); investigation (equal); methodology (equal); writing—original draft (supporting). <b>Dragan","PeriodicalId":73508,"journal":{"name":"iRadiology","volume":"2 1","pages":"96-98"},"PeriodicalIF":0.0,"publicationDate":"2024-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ird3.49","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139624587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}